Reporter

More input in the way Athens Regional Health Systems’ electronic health records system was implemented should have come from the clinicians who use it every day, and fewer decisions should have been made by the hospital’s information technology department, a top hospital administrator and two vice presidents of system vendor Cerner Corp. said this week, in the wake of criticism of the system by a number of physicians.

A lack of training for users also contributed to serious communications and recordkeeping issues within the system, Athens Regional Medical Center Senior Vice President and Chief Medical Officer James L. Moore said.

“Could there have been more information shared at the administrative level? I suppose you could make that argument ... The implementation was through the CIO (chief information officer), and so that’s where the information was held,” he said Wednesday.

The Cerner Millennium system, bought by Athens Regional Health System for $31 million in September 2013, is meant to offer a single source for patient information so providers across the hospital system can communicate and coordinate care on behalf of the patient. Cerner was to provide support and training to help ARHS meet federal regulations requiring ARMC and the other facilities under the Athens Regional umbrella make "meaningful use" of electronic health records and the ICD 10 medical classification list, a revised set of codes for various medical conditions and findings.

But the program, along with hospital administrators in charge of its implementation, quickly garnered criticism from physicians, about a dozen of whom signed a letter sent to former ARMC CEO and President James D. Thaw and Vice President and CIO Gretchen Tegethoff on May 15 after the system went live May 4, saying the “aggressive” project timeline caused communication problems that led to medication errors and put patients at risk.

Soon after the problems with the system were identified, Thaw resigned, followed a few days later by Tegethoff, although hospital officials have not publicly said their resignations were directly related to the Cerner project.

Moore, who took over as administrative lead on the electronic health record system after Thaw resigned, said some of the issues outlined in the physicians’ letter were real, and some were “theoretical.”

“There were some issues where a medication dose was missed. There were some issues where a lab that was ordered in the system and performed and the results didn’t come back across the system, and that had to be fixed,” he said. “As a result, however, on the physicians’ side, and on the nurses’ side, everybody became hyper-vigilant ... To the best of our knowledge, there was not patient harm or patient death.”

Although some daily users of the system were involved in the planning and design process from the beginning, Cerner Vice President Michael Robin, who has worked closely with ARMC since the deal was first made, said his team noticed midway through its implementation that the hospital system’s IT team was leading the project, which is "atypical" of Cerner clients like ARMC, he said.

As part of the seven-year deal with Cerner, Athens Regional Health System agreed to pay about $4 million per year, which a hospital spokesman said was comparable to other systems like Allscripts, the only other company to bid on the project. The Cerner contract includes options to renew for two additional three-year periods.

After the most pressing problems with the system were discovered, Moore said, support staff from Cerner and third-party tech support vendors were sent to Athens to train users one-on-one.

The ambulatory clinic rollout of Cerner was postponed until further notice, according to an internal memorandum sent by Moore to hospital staff on June 3. A special physician support phone line was established for Cerner-specific issues, and, according to the same memo, more analysts were assigned to ARMC and additional training opportunities were added for both physicians and nurses.

ARHS did not respond to a request for figures showing how many Millennium users attended training programs or how much time was spent training users prior to May 4.

“If you look back at this effort, hindsight is 20/20 ... Successful projects — and this is true across the board — are clinically driven, not IT-driven," Cerner Vice President Ben Hilmes said, adding that some important decisions about workflow and design should have been made by the physicians and staff who use Millennium every day, and not by the IT department. “It came out of balance toward the IT side of things."

Hilmes said a consistent level of about 30 Cerner representatives have been on-site working with ARHS personnel. A larger support team was sent to Athens to work through workflow issues about a week after Thaw and Tegethoff resigned.

Clinicians are now directing most of the project operations, said Robin, adding that he feels like the project is “on the right path.”

“The one thing we made clear to Dr. Moore and the board of trustees is that we’re staffing up to meet the needs on-site,” Hilmes said. “Cerner is fully committed here, so we’re doing whatever we need to do to bring the appropriate amount of support to Athens.”